Provider Demographics
NPI:1598742736
Name:MALEY, MICHAEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:MALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:619 RIVER DR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1317
Mailing Address - Country:US
Mailing Address - Phone:201-769-2020
Mailing Address - Fax:201-796-3644
Practice Address - Street 1:619 RIVER DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1317
Practice Address - Country:US
Practice Address - Phone:201-769-2020
Practice Address - Fax:201-796-3644
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD11898207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004241Medicaid
MA2127997Medicaid
RII07832Medicare UPIN
RI007057828Medicare PIN
MA2127997Medicaid